Wellness Section Newsletter - December 2007, Vol 12, #1
Letter from the Section Chair
Julia M. Huber, MD, FACEP
Having just recently returned from Scientific Assembly in Seattle, I feel privileged to have attended meetings of both the Wellness Section as well as the Wellness Committee. Each year I get a stronger sense from the upper echelons of ACEP that there is a compelling need for an atmosphere of wellness among emergency physicians, whether while in training, approaching retirement or anywhere on the professional path. As Mitchell B. Cordover, MD, FACEP, has emphasized, there is a need for a "vocabulary for wellness." This year, so many members reflected on some of the aspects of the convention where wellness could be established: noise levels at some of the parties; need for walking circuits and groups for walking after hours; lists of local eateries with healthy menus; a yoga class at day’s end. We will look at all of these issues and accomplish what we can for future SAs. As I write, I am gathering information from multiple physicians’ colleges that have established "parents with infants" or "nursing moms" lounges during their conventions in order to support those who may need to pump, nurse, or change an infant’s diaper, and I will be reporting back to ACEP about this research.
In conjunction with the ACEP American Association of Women Emergency Physicians (AAWEP) section chair, Kathryn L. Hall-Boyer, MD, FACEP, we will be sending out a questionnaire to members regarding a perceived need for such a room. These moves all seem so simple, but as they add up, they exemplify the lexicon of wellness that many of us hope will eventually pervade the workplace of all emergency physicians. This is all about survival: survival not just as individual physicians, but as a profession. So many of my attendings when I was in medical school encouraged me to avoid emergency medicine, because they guaranteed me I would be burned out and desperate to leave after a few years. Let’s prove them all wrong!
Before I close, I want to take the opportunity to thank all of the people who helped put together the meditation room at the Seattle SA, as well as those who stopped by, even if just for a minute. Our councilor and recent section chair, Dr. Cordover, provided much of the material for the room. Marilyn Bromley, our staff liaison, either wiggled her nose like Sabrina in "Bewitched" or sold her first born to secure the room. This never would have manifested without her. A hearty thank you to Marilyn and all of the staff at ACEP for helping us move forward in our endeavors.
Best wishes for a peaceful New Year and happy festivals of light.
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A number of wellness issues were raised at the Section meeting.
- Family Room. The need for a family room was an issue that was shared by Wellness and AAWEP sections. One member described the pleasure she had in bringing her mother to SA over the years as her guest. Unfortunately, her mother can no longer stand for hours at a time, and there is a shortage of comfortable chairs near the lecture rooms. Another member mentioned the overburdened young man she saw with an infant strapped to his chest, carrying a diaper bag and frustrated because there was no where he could change the baby except the floor. (The changing tables were all in the women’s bathrooms.) Yet another member related that she had been chastised by a fellow physician for nursing her infant "in public" (during a lecture – both to feed the little fellow and to keep him quiet) while she was listening and learning.
The action issue is to try to arrange a Family Room at the next Scientific Assembly. Elsewhere in this issue is a "Needs Assessment" survey written by your new Section Chair, Dr. Julia Huber and by Dr. Kathy Hall-Boyer, the AAWEP Section Chair. Cut and paste your answers (Word does well at that!) and email your answers to firstname.lastname@example.org. Deadline is January 15, 2008. Thank you!
- Noise. The volumes in lecture halls are appropriate, but the social functions can get a bit loud. Various anecdotes were shared by members; the most dramatic was Mitch Cordover’s "When my ears started bleeding, I knew it was too loud!"
The action point: if possible, we will record noise levels during next SA to turn anecdote into data while try to document the noise levels in the various venues.
- Meditation Room. The meditation room was minimally advertised yet fairly well attended. Many thanks to the miracle worker who made it happen, our own staffer!
Next year, Lori Weichenthal, MD, FACEP, who is a certified yoga instructor, has volunteered to lead these sessions.
- Healthy living. SA offers a surfeit of good food and drink. The local venues are unfamiliar to most attendees.
We hope to offer a list of local restaurants serving healthy foods and vegetarian fare. We also want to post times for group running and safe local routes.
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Vicken Y Totten, MD, FACEP
I wanted to introduce myself to you.
My interest in physician wellness began with matriculation 1975. First year students were "educated" in large classrooms. I quickly learned that asking excited questions about the implications of what the lecturer discussed was unhealthy. The paradigm was "open your brain and swallow until you regurgitate." The wards were ruled by sharp hierarchies of power and privilege. Teaching was an exercise in one-upmanship, intimidation and pimping. As a resident, showing ignorance or asking for advice was a weakness that invited attack. I vowed to change it if I could.
More than 30 years later I find myself back in Medical School. Admittedly, it is a different school; one that even then had a reputation for innovative teaching. But what a difference!! My students learn in 3 formats: lecture, seminar and review groups. The "IQ" seminars are nearly self-directed: 9 students together delve deeply into specially designed paper cases. Mondays they review what they know about the topic, and formulate their study objectives. Wednesdays, they review the answers to the study objectives and teach each other and start the next case.
On the wards, every resident and student presents every case directly to an attending. Most discuss the case and go over the physical exam with the student. I rarely if ever hear "What kind of a doctor are you going to be if you don’t know even THAT!!??!"
We are sending out young physicians into the work world who comfortably and easily read about cases, ask others regardless of rank, and collaborate. They are less tolerant of being verbally or physically abused than my generation. It has been a very slow transition; culture change takes generations. But it has changed, and continues to change. May the changes continue toward physician wellbeing!
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Report to the Board of Directors
From the Wellness Committee - ’07 Wellness Update
Mitchell B. Cordover, MD
Chair, Wellness Committee
What follows is a slightly expanded version of what was presented to the ACEP Board of Directors during their October 5, 2007 meeting. The report reflects the perspectives on wellness that the committee and section have long promoted. The Board really gets it! They understand the importance of physician wellbeing to the future of the specialty and to the members of the College. They were very enthusiastic about finding opportunities to serve emergency doctors "where they live and work."
ACEP’s view of Physician Wellness should go far beyond individuals feeling good about work. Our purview should include all aspects of the mental and physical safety and health of Emergency physicians. Wellness IS NOT an entirely personal responsibility. It is the position of the Wellness Committee that it rest in large part on the policies, practices, and support of the College. ACEP’s willingness and ability to influence educational institutions, regulatory agencies and practice locations can foster a work environment that values, promotes, and protects, physician well being. This is precisely what other progressive interest groups, unions, large industries and professional organizations are currently doing.
The Well-being Committee and the Wellness Section applaud the College for its strong interest in this area. We appreciate the opportunity to present this update on recent wellness activities undertaken by both the Wellness Committee and Section.
Wellness impacts on the quality of patient care. A healthy, safe and rewarded physician is the sine qua non of the communication skills, professional relationships, and decision making abilities that are indispensable to this work. It is what we will need to maintain and build on the excellent reputation that emergency medicine has achieved. Our growth into new areas, privileges, and procedures is founded on that reputation. In tern, it is dynamic professional growth that attracts and energizes the best and brightest. Excellent scientific care, compliance with evolving standards, and compassionate patient interactions requires a doctor who is more than merely well informed. It requires a person who is engaged, energetic, and enthusiastic about his or her career in medicine. Even the most committed individual cannot maintain this attitude in a workplace that is capricious, or demeaning, or disrespectful of family, sleep, or personal needs.
Wellness has serious implications for the current and the future condition of the specialty itself. Physicians’ attraction into the specialty, their subsequent retention and loyalty to institutions and to the field and their tendency toward premature retirement or transition out of the Emergency Department are essential long term manpower issues. These issues in large part reflect the ability of those doctors to live a balanced and satisfying life in the context of a round-the-clock 365 day career that is stressful by nature. Our research suggests that staying abreast of the field is a primary concern and one to which ACEP responds with a significant investment in education. Second only to this is the doctors’ concerns about balancing family and professional life.
College services directed at wellness issues should have a disproportionately positive affect on physicians’ willingness to join and stay with ACEP. The College’s political activities are, of course, indispensable and their importance is widely understood. But they seem distant and abstract to many working doctors, while concerns about scheduling, fairness, workplace threats, personal stress, family strain and long term security are their daily life blood. These needs vary throughout one’s work life from the medical student to the physician ready to retire. There are strategies available to answer the needs of each of these stages. Much of the motivation for this year’s work as presented below is aimed at prioritizing those opportunities.
In general, we have chosen to approach Wellness using a standard public health model. This includes Promotion (of healthful lifestyle, interactions, career design/choices, financial education and attitude), Prevention (of injury, contagion, illness and burnout including circadian stress and practice environment), Early Detection (of injury, stressed states, substance abuse and performance decline), Intervention (into stressed states, disruptive behavior, psychiatric disorders, substance abuse, illness and burnout, including litigation stress, medical marriage, etc), and Rehabilitation (from disability, substance abuse, psychiatric disorders, and unhealthful states). We hope to start with guiding policies but ultimately be able to detailed educational and useful templates to help members implement the best practices from current research both in the medical environment and from other 27/7 industries with similar stress profiles. Taking a further page from the pubic health book, it is not just knowledge and attitude that changes behaviors, but programs that facilitate improved practices.
This year the Well-being Committee and Wellness Section actively sought to determine the importance and character of wellness among all categories of College members. This was done through a set of well-designed studies, some of which were supported by the College. Formal reports on each of this year’s research projects will be submitted to the Board of Directors at a later date. However, in a preliminary review, several notable facts will be discussed.
The Board’s ongoing support of the Wellness Booth at Scientific Assembly has created a widely used and much appreciated member benefit. The Committee is deeply indebted to the ACEP staff who, with committee participation, have devoted time and energy to improving, streamlining and redefining the services and procedures of the booth to make it better reflect the member’s needs and to work even more smoothly. Improvements have been made in the registration and through-put process.
1) The Section uses the Wellness Booth as a research opportunity. We provide members who attend Scientific Assembly the opportunity to take the Maslach Burnout Inventory (MBI) at the site of the Wellness Booth. This survey instrument scores:
- Emotional Exhaustion: The degree of stress and strain relative to one’s normal coping skills and attitudes.
- Depersonalization: The degree to which one views others as things or objects rather than as feeling, valuing persons.
- Personal Accomplishment: The degree to which a person sees oneself doing well on tasks worth doing.
Results from MBI indicate:
- Number of physicians taking the survey who have practiced emergency medicine for 20 years or more has risen from 26% in 2004 to 41% in 2006. This reminds of the aging of the membership, but also may reflect both the increased interest in the senior sub population in this matter.
- The average number of years in practice is 15.5 for those taking the MBI
- The trend for the last four years indicates that members are experiencing more emotional exhaustion, depersonalization and less personal accomplishment.
As a result of this information, the Well-being Committee includes materials on coping with these issues when the test results are mailed to members.
2) Questions on wellness were included in a recent national ACEP member survey. The final results are pending, put preliminary analysis indicates that the single biggest personal issue for all individuals surveyed is the balance between work and personal life. Other significant issues according to the respondents were:
- Unsettled about personal options; (career choice ambiguity)
- Building wealth; and
- Concerned about personal liability issues.
We are awaiting the results about how the members see the College’s services in these areas.
3) A randomized survey of 1000 College members over the age of 55 was conducted in an effort to identify issues of concern to this population. This study was supported by an ACEP Section Grant. A preliminary report is provided under separate cover.
The percentage of ACEP members over the age of 50 has increased from 28% to 31% in the past two years. The most common answers to the question "What can ACEP do to help members deal with issues regarding retirement and career longevity?" fell into the following categories (in order of frequency):
- Provide education content on retirement-related issues;
- Advocate for senior members with policies that address problems of shift work and work load;
- Conduct additional survey/studies on the topic of the aging emergency physician.
To immediately address some of these issues, the Well-being Committee and Wellness Section developed:
- Annotated Bibliography for Physician in Pre-Retirement Years;
- A list of resources for emergency physician in the pre-retirement years; and
- Information on Health Screenings for the aging emergency physicians
Specific Board recommendations growing out of this work include convening a multi-section task force this year with the mandate to:
- Produce an disseminating an information paper on the legal rights of physicians regarding discrimination based on age,
- Researching the issue of cognitive and procedural decline and the feasibility of a self administered tool to monitor professional performance,
- Design a long term strategy to address the needs of this group, with the intent to safely maximize the utility of our most experienced physicians.
4) Two groups, residency directors and residents, were surveyed on curriculum development for residents. The response rate was excellent. The study revealed:
- Programs spend an average of only 5-8 hours on wellness topics during the residency training;
- A majority report adequate education in wellness in their program;
- Wellness is a valuable part of the learning curriculum; and
- Administrators support education in resident wellness.
Residents commented that they would value topics on financial planning, impairment, personal organization, time management, interpersonal communication, and scheduling guidelines. Several residents commented that, while they knew many aspects of wellness (getting rest, diet, exercise, and balance between personal and professional life), what they really needed was a "how-to" and observed that it would be of considerable benefit if the residency programs actually modeled wellness. (eg, scheduling shifts and meetings).
5) The Board of Directors approved a Wellness Section grant on the "Tolerance for Uncertainty and Satisfaction with Emergency Medicine." The survey has been completed and a paper is being prepared for publication. However, the preliminary results are enlightening. The Maslow burnout scale was correlated with an equally well validated instrument measuring intolerance to ambiguity.
- 84% of the doctors were residency trained, mean age 41 years with a mean practice time of only 12 years. Most could not see practicing past the age of 50.
- 34% showed high levels of burnout.
- The primary intolerance was to ambiguity over patient outcome, and not the intolerance to expected lifestyle or crowding.
- There was a distinct population that had low burnout and high tolerance to a number of variables
This study suggests some specific areas for physician education and attitude training. More significantly, it suggests that there is a group of doctors who are potentially more resistant to burnout. We need more research to determine what is different about their approach or their environment.
6) In the recent past, the Wellness section developed a course-in-box that is available to residency programs and members to assist in providing information on wellness. Likewise, the recently updated The ACEP Wellness Book has also been of use to residency programs, chapters, and members in providing wellness information. It is our intention to revise this and determine how we can put it to better use.
7) Taking a very liberal and inclusive approach, the Well-being Committee conducted an extensive review of all ACEP policies relevant to emergency physician wellness. Recognizing that ACEP policies should be directed at affirming, supporting and clarifying the College’s stance on emergency physician well-being, it was determined that current policies on issues such a safety, immunization, contagion, circadian stress and scheduling, litigation stress, relationships (family, society and professional), aging, professional satisfaction, impairment, recovery, behavior and psychiatric disorders, fitness and health promotion, fair treatment from regulatory bodies and physician illness and sick leave were in place; however there were some notable gaps. We lack formal policy statements in areas dealing with physical illness, aging and the older physician, and maternity. It was observed that ACEP should have stronger policy statements on licensure and disability, emergency physician well-being during pregnancy and some of the policies that are already in place.
8) In addition to the above, ACEP, under the auspices of its wellness community, offers the following to members:
- Maintains a listing of members willing to serve as litigation stress peer-to-peer counselors and burnout – professional stress peer-to-peer counselors;
- Compiles a listing of individuals willing to speak on a variety of wellness topics;
- Provides support for members who are having problems collecting from their disability insurance company;
- Provides information and materials on how to deal with a colleague that is causing problems in the work place;
- Updates the on-line Wellness Book;
- Offers information on scheduling; and
- Provides information to individual members on a variety of wellness topics.
9) This year, ACEP submitted questions pertaining to physician wellness and disability to be included in the American Board of Emergency Medicine’s (ABEM) longitudinal study. The issue of impairment and being able to sit for the recertification exam was also addressed with ABEM and the Federation of State Medical Licensing Boards. We were assured that provisions are made for the physician in recovery to take the recertification exam.
As emergency medicine matures it inevitably must face the fact that its nature is inherently stressful. If we are to realize our full potential, we will need to rationally organize our resources to prevent our field from injuring those of us who have chosen it.
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Beware the Christmas Blues
Mitchell B. Cordover, MD, FACEP
Let’s be honest! The Christmas season is not much fun for grownups. Incidentally, I know the season includes Eid al-Adha, Kwanzaa, Chanukah, Rohatzu and a few others. The commercial full-court-press and the frenzy of parties, Santae (plural for the nominative Santa), lights, concerts, reindeer and school pageants is colloquially called Christmas, and you all know I am not referring to the religious aspects of the holiday. It is among the busiest times of the year, and since much of the busy is directed to family, there is no time when the conflict between work and home seems more intense. As fate would have it, it is also heart attack, influenza, pneumonia, COPD exacerbation and homeless person frostbite season, so there is a lot to do on both sides of the work-home divide.
How can one keep the cheery and positive intentions of this potentially wonderful time of year from becoming fodder for burnout and depression? Here are some Wellness tips.
- Attend to the basics. Do not trade away sleep. As Americans, and doctors in specific, we habitually get inadequate sleep. In the short winter days, our pineal has programmed us to get MORE sleep, so we are starting with a deficit. Tell your family and yourself. Tip: Sleep time is especially protected time. The same goes for food. The holiday season starts so early these days (Santa was on the shelf as the jack-o-lanterns arrived) that you could spend SIX WEEKS eating badly. The occasional indulgence is not the problem, of course. But the breakdown of our usual vigilance about too much fat, sugar, ethanol and calories in the name of "it’s just for the holiday" can add to your Grinchmas feeling and post Christmas crash. Tip: Be over cautious about between feast meals. Think of it as pay back for the mince pie.
- Guard your schedule. Don’t be tempted to pick up excessive shifts. Because of school holidays and other temptations, there is a competition to take time off during this period. That leaves the rest of us with more shifts than may be comfortable. To add to the seduction, they pay us more to work some of those days. Know your limits. Tip: Put your home chores like hanging lights, shopping, fetes and you work schedule on the same month-at-a glance December calendar. If you are doing too much after a night shift or have NO days just to cool out, you need to cut back.
- Cut back. Really! Some responsibilities are visited on you and there’s no getting out of it. You don’t want to miss your kid’s chance to be the next Yoyo Ma. Tip: Christmas staff parties, block get-togethers, performances of the Nutcracker and Messiah, local college jazz or madrigal dinners, etc. all should go into a pool of optional activities and limit yourself to some point below the "frantic" level. Pick the ones that will refresh you, and few enough ones to stay relaxed.
- Use your tools. Do as much as you can by remote control. Tip: Phone and internet your gifts. If you start now, there is still time for gifts to arrive. If you give gifts of things to do rather than things to have, the Opera will hold your Aunt’s tickets at the Will Call window for you and even include a nice card.
- Lower your gift expectations. For yourself and others. Enough said. Tip: Read Unplug the Christmas Machine, by Jo Robinson.
- Face your demons. Much as been written about the post holiday let-down and the disappointment that seems to grow from not reliving those glowing childhood memories. Or remembering how much you don’t get along with your loud-mouth brother-in-law. Or recalling how much your head hurts. The day after you drink Tequila. Or realizing how many ties you have that you daren’t give away but don’t use because you wear scrubs to work. Well, there are a great many things that we experience differently as adults than we did as children and most of them are the sweeter for maturity. This is a complicated issue, abandoning the expectations of childhood for the evolving pleasure of adulthood, but it can be condensed to a simple mantra. Tip: Remain mindful that this season is full of pleasures reserved for adults. Real family connections, creating childhood memories for your kids, respecting family traditions and the deeper meanings of the underlying holidays are all things you took for granted as a child, and which can reward you now.
- Don’t resent work. It’s true that you could be using the time to overeat or buy new strings of lights that have a shorter half-life than technetium 99, but each of the traditions we celebrate in the winter season teach us that the real satisfaction in life is to live a life of service. Whether you are honoring the birth of Christ, venerating the enlightenment of the Buddha, celebrating the end of the Hajj or the liberation of the Temple, serving the ill and injured is an appropriate way to do it. Remember that it is the Christmas season for your patients, as well. You are in a privileged position to address their holiday experience. As an additional perk, people are cheerier, nurses and otherwise dignified specialists wear amusing hats and there are usually good eats in the break room. Tip: Include the meaning of your into your holiday. Personify the cheery feeling of the season into your interactions. Even if you have to force yourself at first, you will find that it will take hold. Don’t eat too many butter cookies.
So there your have it. A cure to the holiday blues. The best of it all (and none of the stress of it all) to everyone.
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Wellness Section Meeting Minutes
Tuesday, October 9, 2007
4:00 pm – 5:30 pm
Room 212, Convention Center
Attending all or part of the meeting were the section leaders and sixteen members and guests.
Others attending all or part of the meeting included: Alex Rosenau, DO, FACEP, Board liaison; Rhonda Whitson, RHIA; and Marilyn Bromley, RN, staff liaison.
Review of Section Activity
Election of Officers
Presentation: Wellness on the Web
Open forum- discussion
Major Points Discussed
Mitchell Cordover, MD, FACEP, chair of the Wellness Section welcomed everyone to the section meeting. He provided an update on the two grant projects, the Aging Physician Survey and the Ability to Deal with Ambiguity. The leaders of the grants will be providing complete reports in the upcoming months.
Dr. Cordover provided a summary of the report to the Board of Directors and noted the complete report would be included in the next edition of the newsletter.
The group agreed that the Mediation Room was a success. It was noted that with very little promotion people were using the room throughout the day and anywhere from 5-8 had shown up for 6:30am meditation. There was strong consensus that this room should be offered again. The section would like to offer an early morning yoga session. Lori Weichenthal, MD, FACEP is a certified yoga instructor and has volunteered to lead these sessions. Additionally the section will request that next year’s meeting materials include information about where attendees can go to exercise in Chicago.
The section will enhance its work with the AAWEP section. Julia M. Huber, MD, FACEP will take the lead.
Vicken Y. Totten, MD, FACEP indicated she is interested in pursuing research on circadian rhythm issues among emergency physicians. She would like to address the level knowledge about this subject, including what pharmacological coping methods are used, length of shifts, and how emergency physicians cope with shift work as they age. The section agreed that a section grant should be applied for
To further pursue this, Dr. Totten will also check the College’s research information available for members.
S. Shay Bintliff, MD, FACEP, reported on the past success of a chapter grant regarding violence prevention where whistles were handed out along with a pamphlet providing information on mitigating violence. Dr. Bintliff provided whistles for those in attendance and suggested that because violence and in particular violence in the workplace is a real issue for ED personnel that we may wish to consider addressing this issue through the section grant process.
Elections were held:
Lori Weichenthal, MD, FACEP – Chair Elect
Vicken Y. Totten, MD, FACEP –Secretary Newsletter Editor
Mitchell B. Cordover, MD, FACEP – Councilor
Rachelle A. Greenman, MD, FACEP – Alternate Councilor
Julia M. Huber, MD, FACEP was installed as chair.
The meeting was adjourned.
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Needs Assessment for "Parents with Infants" Lounge at Scientific Assembly
Julia M. Huber, MD, FACEP, Wellness Section Chair
Kathryn L. Hall-Boyer, MD, FACEP, AAWEP Section Chair
This questionnaire is being sent to AAWEP and Wellness Section members in order to assess the need for a "Parents with Infants" Lounge at future ACEP Scientific Assemblies. It is becoming increasingly standard for physicians professional organizations to provide such an area at their professional conventions.
Even if you don’t have small children, we would still appreciate your feedback. The questionnaire will appear in various venues, so if you have already responded, please disregard. The results will be used for needs assessment only, and will not be used for any independent research. We will publish results in the AAWEP and Wellness Section newsletters.
Please feel to forward this questionnaire to any colleague who may wish to add his or her input. You may wish to have your partner’s input on some of these questions. Our goal is to share any membership responses with ACEP in order to provide them with information about a possible need to enhance membership attendance and satisfaction at future SAs.
Do you (or your partner) have small children with needs to tend to during SA? If you answered "no", please go to question five.
||If there were a location for you (or accompanying partner/caretaker) to nurse an infant, change an infant or toddler’s diaper, or pump, would you have used it in past SAs?
||My partner or I will need such a location at next year’s SA.
|| If there were a "Parents with Infants Lounge" at SA, it would need:
||Diaper changing table
||Private location to pump breast milk
||Private location to nurse an infant
||Chair for parent/caretaker
||Public signs indicating location
||Access for caretakers accompanying attendee
Other (write-in) _________________________
||There is a need for such a location at ACEP SA.
Comments. May we quote you?
Please send your responses to: email@example.com by January 15, 2008. Thank you!
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Future Wellness Booth Questions
The Wellness Booth continues to be one of the most visited booths at Scientific Assembly. Please see the article elsewhere in this issue. There have been other services suggested or offered at the Wellness Booth in years past. The editor would like to hear from you about what you think should be offered.
||Should the Wellness Booth be expanded?
What else should be offered at the Wellness Booth? ____________________
||Each year at the Wellness Booth, the Maslach Burnout Survey is available for members to self-rate. Should this data be tracked on a yearly basis, and should the college publish the results (anonymously) as research?
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Be Your Own Best Patient: Stay Healthy and Enjoy Your Career as an Emergency Physician
Rebecca Parker, MD, FACEP
Past Chair of the ACEP Young Physicians Section (YPS)
Here it is, almost five months since graduation. Finances are stabilizing, and you're adjusting well to your new role and group. Emergency medicine feels good right now. How do you keep it going? What things should you keep an eye out for and what resources are there when times are tough? In this final issue of In Transition we will assist you in answering these questions.
Although physicians often place their health at the end of the priority list, we all know it is key to our happiness as well as longevity. ACEP’s Wellness section and committee have developed resources to help emergency physicians. In ACEP’s Wellness Book for Emergency Physicians, topics such as burnout, health/diet/exercise, and dealing with stressors are explored. Originally developed in 1995, this book was recently revised and expanded. The chapter on burnout outlines the definition, causes, and symptoms of burnout.
Although financial planning was addressed in previous In Transition issues (e-mail Marjorie Geist firstname.lastname@example.org if you'd like another copy), the topic deserves an extra mention here. By appropriately planning your budget you minimize this universal stress. It's tempting to pick up those extra shifts, but in the end it's not always worth it. Plan your finances appropriately and spend your off time on yourself and your family, not on extra shifts.
Speaking of shift work, understanding and maintaining your circadian rhythm is also key to your health and happiness. ACEP's policy Emergency Physician Shift Work summarizes the best approaches to healthier scheduling, and includes a link to its accompanying policy resource education paper (PREP) Circadian Rhythms and Shift Work. This PREP analyzes sleep and shift work and provides strategies on dealing with this unavoidable aspect of the practice of emergency medicine.
One of the most stressful occurrences in a physician's life is being sued. In her article Litigation Stress, and in the Wellness Book's chapter on litigation, Louise Andrew, MD, JD, FACEP, discusses malpractice litigation and advises on physician coping mechanisms. In her article Dr. Andrew also addresses So You Have Been Sued! Dr. Andrew walks you step by step through the process of a lawsuit. ACEP has numerous other resources on their Medical Liability page.
Whether experienced by you or a colleague, physician impairment is more common than we admit. Resources include ACEP's policy, Physician Impairment and the chapter in ACEP's Wellness Book entitled Physician Impairment as well.
Being part of a community is a crucial part of physician happiness and success. Building your hospital community and spending time with your friends and family will add to your success as a physician. There are also many email listserve communities to which you can subscribe; the most popular in emergency medicine is EMED-L. EMED-L is a world-wide community of over 1,000 emergency physicians, nurses, and medics discussing issues surrounding the practice of emergency medicine. Beware--you may receive many e-mails, so consider the DIGEST command to group the e-mails together.
Organized medicine is another community that provides us with not only endless resources and advice but also a large pool of colleagues and future friends. We hope you continue to use the Section of Young Physicians to develop your communities while introducing you to the community of ACEP. Be sure to attend your chapter's annual and local meetings. Chapter/education meeting information can be found on ACEP's Master Calendar or by contacting your State Chapter.
This article was previously distributed in the final issue of the In Transition series for the class of 2007. Used with permission of the Young Physicians Section Officers.
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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.